LSU budget slashing could work in our favor, medical school officials tell students

Shifting many residency programs to private hospitals will result in a better ratio of patients per resident, they say

LSU medical school officials told students and faculty Tuesday night that changes to resident training under way as part of the budget slashing at the state's public hospital system will eventually make the programs more attractive to prospective residents. At a "town hall" meeting at the medical school in New Orleans, Dr. Larry Hollier, chancellor of the LSU Health Sciences Center, said the shrinking of the public hospitals in recent years has led to residents having too few hospitalized patients to treat under the supervision of attending physicians.

But plans to shift many residency programs to private hospitals will result in a better ratio of patients per resident, he said. Hollier said that even before the most recent cuts, which were announced last week, the number of patients in the public hospitals had shrunk to unacceptably low levels. "The only reason that residents still got such good training is because of the work of the faculty," he said.

Hollier said when he was a resident at CharityHospital, there were 1,500 beds available, but the number of beds had shrunk to 550 before Hurricane Katrina. With the latest budget cuts, there will be 150 beds at the Interim LSU Public Hospital, better known as University Hospital, which took over providing care for the indigent in New Orleans after the closure of Charity Hospital following the storm.

The popularity of Louisiana's programs to train new doctors is considered critically important, as many physicians choose to stay in the state where they complete their residencies.

The most recent cuts to LSU's seven hospitals in south Louisiana were the result of a reduction in the federal Medicaid dollars sent to the state. Gov. Bobby Jindal's administration directed a large share of the cuts at the LSU hospitals, which state officials said would provide an opportunity to remake the system that has traditionally provided the health care safety net for the uninsured.

Dr. Frank Opelka, the newly appointed head of the LSU health system, said he and Louisiana Department of Health and Hospitals Secretary Bruce Greenstein are working on agreements with private hospitals to take over some services that have been reduced or eliminated.

But legislators who learned the details of the $152 million cut last week have questioned whether the reductions will result in the most vulnerable uninsured patients going without necessary medical care as hospital beds disappear and some LSU clinics close or limit hours. State officials have provided few details about what the partnerships with private hospitals will look like, saying those plans are largely still in the works.

Hollier said about half of the patients treated by the LSU hospitals and clinics are covered by Medicaid, Medicare or private insurance. As residency programs move to private hospitals, doctors in the LSU-run clinics will have better availability for insured patients needing surgery or other hospital-based care, he said.

Some in the audience asked whether the uninsured would be left out as a result of the budget cuts and more residencies moving to private facilities. "I feel like we are abandoning our population," said one woman, who identified herself as a second-year medical student.

Opelka said he is focused on ensuring access to care, while Hollier emphasized that LSU will still be caring for the uninsured in the system's many specialty clinics.

One medical student in his last year asked why he should apply for a Louisiana residency, saying many of his fellow students are skeptical of the changes under way. Hollier emphasized that LSU's "outstanding faculty" will still be teaching, just in different settings. He also noted that the University Medical Center is currently under construction just outside downtown New Orleans, and said it will be an up-to-date hospital where next year's residents will finish their training.

Under the plans for the residency programs, some New Orleans-based residents will continue to train at the downtown InterimLSUPublicHospital, while others will be moved to private hospitals. Opelka has said that under the reworking of graduate medical education, 25 percent of residents will train in public hospitals, compared to about 50 percent now.

Hollier said the school is in talks with Ochsner Health System and Touro Infirmary for LSU doctors to treat patients and train residents at their facilities.

In Baton Rouge, where beds at Earl K. Long Hospital will be significantly reduced, many faculty and students will move to Our Lady of the Lake Medical Center, which was already slated to take over much of the public hospital's patient load. Lafayette General will take over the LSU programs in that city, Hollier said.

Residency programs are attractive to hospitals because they come with federal Medicare dollars. Any changes to the state's programs will need to be approved by national groups that accredit the programs.